State, city, and county workers. Enjoy your life in good health.

Transcription

1 State, city, and county workers Enjoy your life in good health. April 2019

2 Aloha, Your life is a journey and we re with you every step of the way. Whether you re single, starting a family, raising kids, or preparing for retirement, our health plans get you the care you need. We re proud to offer you plans that give you: Freedom to choose from thousands of local doctors and health care providers. Quality care from Hawaii s top doctors and hospitals. Convenient care options that go beyond the doctor s office and emergency room. Peace of mind with benefits when you travel to the Mainland and around the world. We ve partnered with the EUTF to offer you new benefits in You can learn more about these benefits on the next page. This year s open enrollment is April 1 to 30, If you have questions, we re happy to help. Call or visit us at an HMSA Center or office. Our phone numbers, locations, and hours are listed on the back of this guide. Your life is indeed a journey. At HMSA, we understand that and tailor our benefits and services to be with you at every step. Mahalo, Michael B. Stollar President and Chief Executive Officer 1

3 What s new in 2019 You get the best with HMSA Knowing what your health plan pays for can help you stay healthy and save money. These changes start July 1, New for EUTF and HSTA VB members Genetic counseling provides information and support to people who have or may be at risk for certain inherited health conditions. This service will be a plan benefit when seeing a provider in our network. Advance care planning lets your doctor and family know how you want to be cared for if you can t make health care decisions on your own. This service will be available at no cost when you see a provider in our network. Chlamydia and gonorrhea screenings for men will be covered at no cost. New for EUTF members The annual physical exam will change to an annual preventive health evaluation (APHE). This service will be available at no cost when you see a provider in our network. The APHE includes: A health assessment. A review of your health history. Discussion of health risks. Review of any prior screening test results. Additional screenings as needed. New for HSTA VB members The Ornish Lifestyle Medicine program is a benefit that can help eligible members who have or are at risk for heart disease improve their health through lifestyle changes. HMSA s Diabetes Prevention Program is a benefit that can help eligible members lose weight, feel better, and prevent or delay type 2 diabetes. Supportive care is medical care that improves a patient s comfort and quality of life. This service can help members who have a serious illness or condition get palliative or holistic comfort care while they receive treatments or life-prolonging therapy. It s available at no cost when you see a provider in our network. This is only a summary. For complete information, see your plan s Guide to Benefits, which can be found on hmsa.com/eutf. All benefits are for services from a participating provider. Learn more about the benefits of being an HMSA member at every stage of your life. Choose your own doctors and specialists. Members can choose from a large network of 7,500 doctors, specialists, and other health care providers. Go to Hawaii s top-rated hospitals and clinics. Hospitals and medical centers in our network specialize in childbirth, cardiac care, cancer treatment, full-service women s care, spine surgery, bariatric surgery, and more. Access convenient after-hours care. Need care that can t wait until the next day but isn t an emergency? You have lots of options. Connect with a doctor online with HMSA s Online Care, visit an urgent care clinic, or go to a CVS/minuteclinic, the medical clinic in selected Longs Drugs stores on Oahu. Online Care is available at no cost for all EUTF active plan members. Get care when you travel. Going on a trip to the Mainland or another country? Your plan gives you access to care on the Mainland and around the world. Live healthier. Our tools and programs can help you live healthier and happier at little to no cost. Whether you want to lose weight or manage your stress, we offer programs and services that can help you reach your goal. Save money on your health and fitness. Our member discount program helps you save on healthrelated products and services like fitness classes, acupuncture, massage therapy, gym memberships, and more. Go to page 7 to learn more about our well-being tools and programs. AmericanWell is an independent company providing hosting and software services for HMSA s Online Care platform on behalf of HMSA. 2 3

4 Top-rated hospitals and clinics It s easy to use your health plan With HMSA, you ll have access to specialty care from top-rated hospitals. Adventist Health Castle has earned national honors for constantly improving the delivery of quality care for patients. Kapi olani Medical Center for Women & Children is Hawaii s only full-service women s and children s hospital. The Queen s Medical Center is the main trauma center in the Pacific Basin and the state s only organ transplant center. Straub Medical Center is the Pacific region s only multidisciplinary burn treatment center. Blue Cross Blue Shield Association recognizes these Hawaii hospitals for expertise in delivering quality and cost-effective specialty care. Kapi olani Medical Center for Women & Children and Wilcox Medical Center for maternity care. Straub Medical Center for cardiac care. The Queen s Medical Center for spine surgery. Adventist Health Castle for bariatric surgery. Adventist Health Castle, Pali Momi Medical Center, and Straub Medical Center for knee and hip replacement. We re proud to work with these health care providers to offer you quality care: Choose from quality health plans Our preferred provider organization (PPO) plan gives you the most freedom to choose your own primary care provider (PCP) and get specialty care without a referral. You can see providers who aren t in our network at a higher cost. With the health maintenance organization (HMO) plan, you ll choose a PCP and a health center. Your PCP will coordinate your care. You ll need a referral to see specialists who aren t in your health center. You won t need a referral for basic health care services like urgent and preventive care. Find a PCP or other health care provider Go to hmsa.com/eutf to use the Find a Doctor tool. Just remember to choose the plan you have before starting your search. Get after-hours care Connect with a doctor on your computer or mobile device from anywhere in Hawaii with HMSA s Online Care. Online Care doctors are available 24 hours a day, seven days a week. This benefit is available at no cost for EUTF members. See a doctor at urgent care clinics in our network. To search for urgent care providers, go to hmsa.com/urgentcare. See a doctor or nurse practitioner at CVS/ minuteclinic, the medical clinic in selected Longs Drugs stores on Oahu. To find a CVS/minuteclinic, use the Find a Doctor tool on hmsa.com/eutf. 4 5

5 Get care around the world Be well, be strong With HMSA, there are lots of ways to take care of your health and well-being. Here are some of the benefits and programs available to you. Go to hmsa.com/eutf to learn more. Preventive care If you re an EUTF Active plan member, see your PCP for an annual preventive health evaluation (APHE). HSTA VB Active plan members should schedule a physical exam with their PCP. It s a good way to stay on top of your health and prevent or treat major health problems before they start. These services are available at no cost when you see a PCP in our network. With HMSA, you and your eligible dependents can get care on the Mainland and in many international locations. How it works HMSA is part of the Blue Cross Blue Shield network, which includes 96 percent of doctors and 95 percent of hospitals on the Mainland. Your HMSA plan will also protect you in nearly 170 countries around the world. Looking for a doctor or hospital on the Mainland? Go to bcbs.com. Traveling internationally? Download the Blue Cross Blue Shield Global Core mobile app for Apple and Android devices. You can use the app to search for providers when you travel. To learn more, go to bcbsglobalcore.com. Be prepared Before you go, make sure you have your current HMSA membership card with you. Your card will help providers file your claims. You can also call 1 (800) 810-BLUE (2583) for the names of participating doctors and hospitals in the area you ll be visiting. Subscriber Name KIMO K ALOHA Subscriber ID XLER Group EUTF MEDICAL 690 CMPCARE C14 Learn more about our Care Access Assistance Program If you have a PPO plan and need to travel to another island for medical treatment, you may be eligible for financial assistance if your care isn t available from a participating provider on your home island or you can t get an appointment soon enough. Call us at 1 (844) toll-free to learn more about this program. The HMSA Pregnancy Support Program You ll be matched with an experienced maternity nurse to answer your questions and supplement the care you receive from your ob-gyn. You ll also receive a guide for pregnant women. You must be eligible to enroll in the program. Active&Fit Direct Save on memberships to gyms and fitness centers with Active&Fit Direct. Member discounts Get exclusive discounts on yoga, massage therapy, acupuncture, and other health-related services. Go to hmsa.com/well-being to learn more. Chiropractic care Go to chiropractors in the American Specialty Health (ASH) network for up to 20 medically necessary visits per calendar year at a $15 copayment per visit for EUTF active members and a $12 copayment per visit for HSTA VB members. To find a chiropractor, go to ashlink.com/ash/hmsa or call 1 (888) toll-free. Health and well-being support Sometimes we need a helping hand. Call 1 (855) toll-free to connect with a health coach or learn more about chronic disease management. Island Scene magazine Get health tips and inspiration in Island Scene, HMSA s member magazine. You can also find food videos, upcoming events, and more on islandscene.com. Ornish Lifestyle Medicine program Do you have or are you at risk for heart disease? Improve your health through diet, exercise, stress management, and group support through the Ornish Lifestyle Medicine program. You must be eligible to enroll in the program. Active&Fit Direct is a trademark of ASH. The Active&Fit Direct program is provided by American Specialty Health Fitness, Inc., a subsidiary of ASH. American Specialty Health (ASH) is an independent company providing chiropractic, acupuncture, fitness programs, and/or massage therapy services on behalf of HMSA. 6 7

6 Get healthy with Sharecare Take the first step to a healthier you with Sharecare s RealAge Test, a health assessment that tells you your body s age versus your calendar age. Then use Sharecare to track your health and improve your RealAge over time. Go where your well-being takes you. Enter to win a vacation of your choice ** at hmsa.com/sharecare. All you have to do is: 1. Register for Sharecare at hmsa.com/sharecare using your HMSA subscriber ID number and personal Take the RealAge Test by June 30, $ 3,500** hmsa.com/eutf As an HMSA member, you can view all your health plan information and member benefits online on My Account at hmsa.com/eutf. Use My Account to: View your claims. Use an annual maximum out-of-pocket calculator to see the most you ll pay for covered services in a plan year. See where you are with reaching your deductible, if applicable. Download your plan s Guide to Benefits for detailed information about your HMSA plan. In addition to My Account, you can use the web page to: Search for a doctor. Find health and fitness member discounts with HMSA365. Learn more about the well-being programs available to you and your family. How to use My Account To log in or register for My Account, go to hmsa.com/eutf and click Member Login. If you re logging in, enter your information and click Login. If you re registering, click Register. Then enter a valid address, create a password, and click Register. ** Prizes are subject to federal and state taxes. Please consult your tax adviser. Active employees receiving prizes may have the value of the prize added into their payroll and W-2. Retirees and dependents may receive Form 1099 from HMSA. This drawing is exclusive to EUTF active employees, retirees, and their dependents over the age of 18. For official rules, go to hmsa.com/eutf. Each eligible entrant who registers for Sharecare, links his/her EUTF HMSA subscriber ID number, and completes the RealAge Test within the promotional period will receive a chance to win one of two $3,500 Panda Travel vouchers subject to certain restrictions. RealAge is a registered mark of Sharecare, Inc. Sharecare, Inc., is an independent company that provides health and well-being programs to engage members on behalf of HMSA. 8 9

7 EUTF health plan comparison Which plan works best for you? Use this chart to compare the plans and choose the one that fits your health and budget needs. Participating providers (doctors in our network) have contracts with HMSA and agree to charge members a set amount for covered services. One way to maximize your benefits and save money is to see doctors in our network. Nonparticipating providers (doctors who aren t in our network) can set their own rates, which may be more than the contracted rate our participating providers charge. If you receive services from a nonparticipating provider, you ll likely have higher out-of-pocket costs. Health care terms The deductible is the amount you pay for certain services each calendar year before your health plan pays. The dollar amount applied to the deductible is based on the participating provider s eligible charge. Coinsurance is your share of the cost for health care services. It s usually a percentage of the amount charged for services. You start paying coinsurance after you ve paid the deductible. Copayment is the fixed amount you pay to receive a service. The amount can vary by type of service. Eligible charge is the negotiated rate participating providers can charge as part of their contract with HMSA and is what your coinsurance or copayment is based on. Nonparticipating providers can charge beyond this rate and you ll still have to pay the coinsurance or copayment and any difference between the eligible charge and the nonparticipating provider rate. The out-of-pocket maximum is the most you ll have to pay per calendar year for health care services. Once you reach the out-of-pocket maximum, your plan pays 100 percent of the allowed amount for covered services excluding taxes. This is only a summary. For complete information, see your plan s Guide to Benefits, which can be found on hmsa.com/eutf. All benefits are for services from a participating provider. For a comparison of HSTA VB plans, please visit hmsa.com/eutf. ANNUAL OUT-OF-POCKET MAXIMUM (The most you pay out-of-pocket in a calendar year.) ANNUAL DEDUCTIBLE (The amount you pay out-of-pocket in a calendar year before your plan pays.) EUTF 90/10 PPO PLAN 80/20 PPO PLAN 75/25 PPO PLAN HMO $2,000 per person $4,000 maximum per family In-network: None Out of network: $100 per person $300 maximum per family $2,500 per person $5,000 maximum per family In-network: None Out of network: $250 per person $750 maximum per family $5,000 per person $10,000 maximum per family $300 per person $900 maximum per family $1,500 per person $3,000 maximum per family In-network SERVICES YOU PAY YOU PAY YOU PAY YOU PAY Office Visits 10% 20% 25% $15 Annual Preventive Health Evaluation $0 $0 $0 $0 Hospital Room and Board 10% 20% 25%* $0 Maternity Care 10% 20% 25%* $0 Surgical Procedures (outpatient surgery) 10% 20% 25%* None $0 (outpatient surgical center) $15 (professional charges) Diagnostic Tests 10% 20% 25%* $0 Outpatient Laboratory 10% 20% 25% $0 Outpatient X-ray and Other Radiology 10% 20% 25%* $15 per X-ray Emergency Room 10% 20% 25%* $100 Ambulance (ground) 10% 20% 25%* 20% Chiropractic Services $15 copayment per visit for up to 20 medically necessary visits per calendar year when you see an ASH in-network provider $15 copayment per visit for up to 20 medically necessary visits per calendar year when you see an ASH in-network provider $15 copayment per visit for up to 20 medically necessary visits per calendar year when you see an ASH in-network provider $15 copayment per visit for up to 20 medically necessary visits per calendar year when you see an ASH-in-network provider * Annual deductible applies

8 Federal law requires HMSA to provide you with this notice

9 Serving you Meet with knowledgeable, experienced health plan advisers. We ll answer questions about your health plan, give you general health and well-being information, and more. Visit hmsa.com for directions. HMSA Honolulu 818 Keeaumoku St. Monday through Friday, 8 a.m. 6 p.m. Saturday, 9 a.m. 2 p.m. HMSA Pearl City Pearl City Gateway 1132 Kuala St., Suite 400 Monday through Friday, 9 a.m. 7 p.m. Saturday, 9 a.m. 2 p.m. HMSA Hilo Waiakea Center 303A E. Makaala St. Monday through Friday, 9 a.m. 7 p.m. Saturday, 9 a.m. 2 p.m. HMSA Kahului Puunene Shopping Center 70 Hookele St., Suite 1220 Customer Relations representatives are also available in person at our Neighbor Island offices, Monday through Friday, 8 a.m. to 4 p.m.: Kailua-Kona, Hawaii Island Henry St., Suite 301 Phone: Lihue 4366 Kukui Grove St., Suite 103 Phone: Contact HMSA. We re here for you. Call on Oahu or 1 (800) toll-free on the Neighbor Islands or Mainland. Monday through Friday, 7 a.m. 7 p.m. Saturday, 9 a.m. 1 p.m. hmsa.com/eutf askhmsa Together, we improve the lives of our members and the health of Hawaii. Caring for our families, friends, and neighbors is our privilege. (8) AMS fn